Heart Failure Fluid Overload
Case Study Worksheet – Instructor Copy
Mr. Johnson is a 63-year-old man with history of hypertension, chronic heart failure, and sleep apnea.
He has been smoking 2 packs of cigarettes a day for 40 years and has refused to quit. His wife reports
that he has been increasingly “more short of breath” along with “swelling” in his legs and feet for the
past 3 days”. He “sits up all night because he cannot lay down”. He has refused to take any of his
medications: lisinopril, digoxin, hydrochlorothiazide, and Lasix. Mrs. Johnson states he fell when
attempting to get out of bed during the night. She called EMS to “check him”. Mr. Johnson was
transported to the Hospital by EMS and was admitted to the hospital Cardiac Care unit in Acute
Decompensated heart failure.
Your assessment reveals the following:
Subjective Data
Mr. Johnson is restless and anxious
Denies pain but states he “cannot get enough air”
States his “heart feels like it is running away”
States he is “exhausted”
Objective Data
Height 5’10” Weight 260 lbs.
T 98.6 - Pulse 118 and irregular - Respirations 34 - BP 90/58
All peripheral pulses 1+, bilateral vein distension, atrial fibrillation with ventricular rate 132,
distant S1,S2,S3,S4 present
Respiratory – Pulmonary crackles. Decreased breath sounds bilaterally, productive cough frothy
blood-tinged sputum, SPo2 on room air = 82%
GI - BS present all quadrants, hepatomegaly 4cm below costal margin
3 to 4+ edema lower legs and ankles
Answer the Following Questions after Reviewing the Information Above
1. What signs and symptoms of right sided and left sided heart failure is Mr. Johnson Experiencing?
Right Sided- Swelling, Edema, vein distension, decreased O2 rate, and afib
Left sided- Crackles, orthopnea, increased heart rate, frothy sputum
2. What diagnostic procedures and results would you expect for Mr. Johnson?
ECG and an echocardiogram to check the function of the heart, chest xray to look at the lungs to
see if fluid is built up, MRI, and a stress test.
The results that I would expect is that the echocardiogram would show that the heart valves are
not working properly. The ejection fraction for this patient would be low (<50). There will
probably be fluid in the patient’s lungs shown on the xray.
3. What monitoring will be used to evaluate Mr. Johnson’s condition?
Case Study Worksheet – Instructor Copy
Mr. Johnson is a 63-year-old man with history of hypertension, chronic heart failure, and sleep apnea.
He has been smoking 2 packs of cigarettes a day for 40 years and has refused to quit. His wife reports
that he has been increasingly “more short of breath” along with “swelling” in his legs and feet for the
past 3 days”. He “sits up all night because he cannot lay down”. He has refused to take any of his
medications: lisinopril, digoxin, hydrochlorothiazide, and Lasix. Mrs. Johnson states he fell when
attempting to get out of bed during the night. She called EMS to “check him”. Mr. Johnson was
transported to the Hospital by EMS and was admitted to the hospital Cardiac Care unit in Acute
Decompensated heart failure.
Your assessment reveals the following:
Subjective Data
Mr. Johnson is restless and anxious
Denies pain but states he “cannot get enough air”
States his “heart feels like it is running away”
States he is “exhausted”
Objective Data
Height 5’10” Weight 260 lbs.
T 98.6 - Pulse 118 and irregular - Respirations 34 - BP 90/58
All peripheral pulses 1+, bilateral vein distension, atrial fibrillation with ventricular rate 132,
distant S1,S2,S3,S4 present
Respiratory – Pulmonary crackles. Decreased breath sounds bilaterally, productive cough frothy
blood-tinged sputum, SPo2 on room air = 82%
GI - BS present all quadrants, hepatomegaly 4cm below costal margin
3 to 4+ edema lower legs and ankles
Answer the Following Questions after Reviewing the Information Above
1. What signs and symptoms of right sided and left sided heart failure is Mr. Johnson Experiencing?
Right Sided- Swelling, Edema, vein distension, decreased O2 rate, and afib
Left sided- Crackles, orthopnea, increased heart rate, frothy sputum
2. What diagnostic procedures and results would you expect for Mr. Johnson?
ECG and an echocardiogram to check the function of the heart, chest xray to look at the lungs to
see if fluid is built up, MRI, and a stress test.
The results that I would expect is that the echocardiogram would show that the heart valves are
not working properly. The ejection fraction for this patient would be low (<50). There will
probably be fluid in the patient’s lungs shown on the xray.
3. What monitoring will be used to evaluate Mr. Johnson’s condition?
